Complications associated with surgically placed central venous catheters in low birth weight neonates.

Objective: To determine the incidence of complications in low birth weight neonates with surgically inserted central venous catheters (CVCs).

Study Design: Retrospective chart review of all neonates < or = 1500-gm birth weight from three tertiary care neonatal intensive care units who required CVC insertion.

Results: A total of 112 CVCs was inserted in 104 neonates with birth weight of 798 (490 to 1380) gm, age 16 (3 to 179) days, for a duration of 21 (1 to 130) days.

Outcome following pulmonary haemorrhage in very low birthweight neonates treated with surfactant.

Aim: To determine if pulmonary haemorrhage after surfactant treatment increases short and long term morbidity and mortality in neonates weighing <1500 g at birth.

Methods: Neonates weighing <1500 g at birth who developed pulmonary haemorrhage after surfactant treatment were identified from a database. Based on the change in FIO2, pulmonary haemorrhage was classified as mild, moderate, or severe.

The role of fetal karyotyping from unconventional sources.

Objective: Our purpose was to determine whether fetal specimens, including pleural, ascitic, pericardial, facial, and cystic hygroma fluid or urine, are suitable sources for accurate chromosomal analysis.

Study Design: Thirty-nine samples of fetal fluid (pleural, n = 11; ascitic, n = 5; pericardial, n = 1; lung cyst, n = 1, facial cyst, n = 1; cystic hygroma, n = 7; and urine, n = 13) were cultured and analyzed with standard cytogenetic techniques for lymphocytes or amniotic fluid. These samples were obtained as part of the routine obstetric investigation and management.

Surfactant replacement in neonates with early chronic lung disease.

Objective: To study the effect of a single dose of exogenous bovine surfactant on oxygen and ventilatory requirements of neonates with early chronic lung disease.

Study Design: Prospective pilot study.

Setting: Three regional neonatal intensive care units.

Surfactant therapy in neonates with respiratory deterioration due to pulmonary hemorrhage.

Objective: To study the effect of exogenous bovine surfactant on oxygen and ventilatory requirements in neonates with respiratory deterioration due to pulmonary hemorrhage.

Design: Retrospective case series.

Setting: Three regional neonatal intensive care units.

Impact of time since last meal on the gestational glucose challenge test. The Toronto Tri-Hospital Gestational Diabetes Project.

Objective: The purpose of the study was to evaluate the impact of time since the last meal on the glucose challenge test and to find cut points that are most likely to predict the outcome of the oral glucose tolerance test in patients screened for gestational diabetes.

Study Design: This prospective analytic cohort study was carried out at the University of Toronto Perinatal Complex. A 50 gm glucose load was given at 26 weeks' gestation and the time since previous meal ingestion was recorded.

Absent end-diastolic flow velocity waveforms in the umbilical artery--the subsequent pregnancy.

Objective: Our purpose was to assess the recurrence risk, course, and outcome of subsequent pregnancies in women with absent umbilical end-diastolic velocity.

Study Design: Absent umbilical end-diastolic velocity was detected in 88 women. Sixteen of them were prospectively followed up in their 19 subsequent pregnancies.

Transvaginal Doppler assessment of the fetal cerebral circulation.

Blood flow velocity waveforms were recorded by pulsed Doppler examination of the fetal internal carotid and middle cerebral arteries using the established transabdominal route as well as a new transvaginal approach. Fourteen normal controls and 11 pregnancies complicated by intrauterine growth retardation were studied. Satisfactory recordings were obtained in all 25 cases.

The outcome of triplet gestations complicated by fetal death.

Intrauterine death in twin pregnancies has been reported to be associated with a very high incidence of morbidity and mortality in the surviving co-twin, mostly attributed to vascular disruption when vascular anastomosis exists between the twins' circulations. The present study describes the obstetric, neonatal, and follow-up data of five triplet gestations complicated by intrauterine death of one or two fetuses, compared with a control group of triplets matched for gestational age. Delivery occurred an average of 30 +/- 26 days after the diagnosis of intrauterine fetal death.

Epidural anaesthesia and blood flow velocity in mother and fetus.

Doppler ultrasound has recently been used to assess changes in blood velocity in the uterine and umbilical arteries. Alterations in the ratio of systolic to diastolic velocity (S/D ratio) are believed to reflect changes in placental vascular resistance. We have used this technique to assess potential beneficial or detrimental effects of epidural anaesthesia on blood flow to the placenta.

Fetal and maternal hemodynamic responses to exercise in pregnancy assessed by Doppler ultrasonography.

It is common for women to undertake vigorous exercise in the late phase of pregnancy. This may have detrimental effects on the blood flow to the uterus and placenta or from the fetus to the placenta. Fifteen pregnant women with no obstetric or medical complications were subjected to a 5-minute exercise period.

Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period.

The follow-up records of 605 infants with birth weights of less than 1,500 g, with data available for 2 years after birth, were examined for evidence of abnormal pulmonary signs or symptoms. A total of 119 infants were identified and the neonatal oxygen requirements of these infants were compared with those of 486 infants who had normal pulmonary function. A requirement for oxygen at 28 days of life had a positive predictive value for abnormal pulmonary findings at the time of follow-up of only 38%, whereas 31% of those with normal pulmonary findings at the time of follow-up were still receiving oxygen at this age.

Serial measurements of cerebral blood flow velocity in preterm infants during the first 72 hours of life.

Serial measurements of cerebral blood flow velocity (CBFV) were made in 29 preterm infants, using continuous wave Doppler ultrasound. CBFV was measured in both anterior cerebral arteries and quantitative measurements of CBFV were determined using the area under the velocity curve. In all ventilated infants, CBFV increased significantly during the first 6 hours of life and continued to increase until 16 hours of age.

Complications following oral administration of exchange resins in extremely low-birth-weight infants.

Complications of the oral use of sodium polystyrene sulfonate and calcium polystyrene sulfonate are reported in five extremely low-birth-weight infants in which exchange resins were used to treat hyperkalemia. Radio opaque masses outlining the stomach were seen in all infants and could be palpated in the left upper quadrant of the abdomen. In two infants, at autopsy the palpable mass could be identified as a solid chalk-like concretion outlining the stomach.

Umbilical artery flow velocity waveforms and the placental vascular bed.

Umbilical artery Doppler studies were performed close to delivery in 17 women (seven with healthy pregnancies and 10 complicated by intrauterine growth retardation), and results were analyzed by calculating the pulsatility index. In each case the placenta was examined histologically, and the small arteries and arterioles were counted in the tertiary stem villi. A highly significant negative linear relationship was found between pulsatility index and mean small arterial vessel count per field (r = 0.